© 2004 The Royal College of Psychiatrists
One hundred years ago |
The problem of the feeble-minded
Emeritus Consultant Psychiatrist, Horton Hospital, Epsom, Surrey
DR. TREDGOLD’s paper read at the Guild-hall Conference on the Feeble-minded has now been printed, and will be found to contain a very succinct discussion of the sociological bearings of the efforts now being widely made to improve the condition of the mentally defective class. He points out "that with the exigencies of civilized life, the demands upon the intellectual faculties of the individual become daily more exacting", and consequently that it is highly important to the community to devise means to prevent those who by original infirmity are incapable of meeting them from swelling the ranks of pauperism, crime and insanity. Defining amentia, or mental deficiency, as the manifestation of an imperfect or arrested development of certain cells of the brain, in the great majority of cases due to a defect inherent in the germinal plasm, Dr. Tredgold deduces from the teachings of experience, as well as of etiology, that cure is out of the question; yet training can do much, at any rate for the milder grades of defect, though effective training involves a large expenditure of time and money. Such an expenditure, however, he argues, is not wasted if thereby such unfortunates may be prevented from drifting into pauper vagrancy, into crime, and into insanity, a course which entails upon the community a charge far in excess of that of even specialized education. He does not agree with the views held by some that "all patients suffering from whatever degree of mental defect should be subject to permanent detention", and contends that "so long as the feeble-minded, or any other section of society, are capable of earning an honest living, it appears unjustifiable to interfere with their liberty". At the same time, he recognizes the necessity of judicious after-care even for them, and alludes to the scope there is for philan-thropic persons to form associations for this purpose, and perhaps also to provide industrial colonies or boarding-houses of a voluntary character. But training alone does not solve the whole problem, "since it fails in one-third, and is only partially successful in another third of the cases"; and so, in addition to (1) adequate training and (2) after-care associations, Dr. Tredgold advocates (3) the establishment of industrial colonies for the permanent detention of those who are only partially self-supporting, and (4) cheaper institutions for the permanent detention of the failures. The last-mentioned class, he thinks, might fittingly be dealt with under the provisions of the "Idiots Act" so far as detention is concerned: but the difficulty everywhere, except, perhaps, in the metropolitan area, is the lack of sufficient accommodation for unimprovable imbeciles, which Dr. Tredgold thinks the county councils, either singly or in combination, should be required to provide.
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